Stroke remains one of the top causes of mortality and morbidity in the United States, according to the CDC. A wealth of studies inform us on issues ranging from identifying chronic diseases that increase stroke risk to examining the roles of medications and lifestyle in managing risk.

Age-related Macular Degeneration (AMD)

In the ARIC study, stroke risk was approximately 50 percent greater in patients who had AMD compared to those who did not. This increase was seen in both types of stroke: ischemic (complete blockage of blood flow in the brain) and hemorrhagic (bleeding in the brain).

The risk was greater for hemorrhagic stroke than for ischemic. If you have AMD, you should be followed closely by both an ophthalmologist and a primary care physician.

Rheumatoid arthritis (RA)

In an observational study published in the British Medical Journal, patients with RA had a 30 percent increased risk of stroke, and those under 50 years old with RA had a threefold elevated risk. There was also a 40 percent increased risk of atrial fibrillation (AF), a type of arrhythmia or irregular heartbeat.

Generally, AF causes increased stroke risk. The authors suggest checking regularly for AF in RA patients, and they surmised that inflammation may be an underlying cause for the higher number of stroke events.

Medications: Statins and Valsartan

In one study, there was an almost sixfold reduction in mortality from stroke in patients who had high cholesterol and who were on statins at the time of the event. There was also significant mortality reduction in those on a statin without high cholesterol, but with diabetes or heart disease.

The authors surmise that this result might be from an anti-inflammatory effect of the statins. Statins do have side effects; however, used in the right setting, statins are very effective.

Valsartan is an angiotensin II receptor blocker that works on the kidney to reduce blood pressure. However, in an analysis of the Kyoto Heart Study data, valsartan used as an add-on to other blood pressure medications showed a significant reduction, 41 percent, in the risk of stroke and other cardiovascular events for patients who have coronary artery disease.

Medication combination: negative impact

In a randomized controlled trial, an aspirin and Plavix (clopidogrel) combination significantly increased the risk of major bleed and death. The study was halted due to these effects.

The American Heart Association recommends monotherapy for the prevention of recurrent stroke. If you are on this combination of drugs, please consult your physician.

Additionally, the Nurses’ Health Study showed that foods with flavanones, found mainly in citrus fruits, decreased the risk of ischemic stroke by 19 percent. The authors suggest that the reasons for the reduction may have to do with the ability of flavanones to reduce inflammation and/or improve blood vessel function.

Fiber’s important role

Fiber also plays a key role in reducing the risk of a hemorrhagic stroke. In a study of over 78,000 women published in the American Journal of Epidemiology, those who consumed the most whole grain fiber had a total stroke risk reduction of 34 percent and a 49 percent risk reduction in hemorrhagic stroke.

Refined grains, however, increased the risk of hemorrhagic stroke twofold. Read labels carefully, since some products that claim to have whole grains contain unbleached or bleached wheat flour, which is refined.

Ideally, the best option to help reduce the risk or the recurrence of a stroke involves lifestyle modifications. Some patients may need to take statins; however, statins’ side-effect profile is dose-related. Therefore, if you need to take a statin, lifestyle changes may help lower your dose and avoid harsh side effects.